Pulmonary arterial hypertension (PAH) is a Rare Disease that causes an increase in the pulmonary vascular resistance and an increase in blood pressure in the pulmonary circulation. The reduced blood flow through the lungs is accompanied by an insufficient supply of oxygen to the body. As a consequence, patients suffer from lethargy, shortness of breath and a drop in physical performance. If PAH is left untreated for two or three years after first diagnosis has been made, it will lead to life-threatening heart failure. Early diagnosis and commencement of proper treatment are important for the progress of the disease and the prognosis.
Pulmonary hypertension occurs when the mean arterial blood pressure in the pulmonary artery increases above 25 mmHg during rest (normal pressure: <20 mmHg).
Pulmonary hypertension means that there is an increase in pressure in the pulmonary circulation due to a narrowing of the blood vessels in the lungs. This places extra strain on the heart as it tries to continue pumping a sufficient amount of blood through the narrowed blood vessels of the lungs. These blood vessels will continue to narrow and become increasingly inelastic. If the arteries (the blood vessels that lead away from the right ventricle of the heart) are affected, then the disorder is called pulmonary arterial hypertension.
As the disease progresses, the right heart muscle mass will continue to increase in size to the point that the heart will finally lose the ability to pump enough blood into the lungs. The supply of oxygen to the body and heart will then deteriorate further. If the disease is left untreated, it will eventually lead to heart failure.
There are four types of pulmonary hypertension. Pulmonary arterial hypertension is one type and can be further divided into:
The primary symptom of the disease is overwhelming fatigue and lack of breath to the extent that breathing assistance may be necessary.
Other symptoms that may be present include:
If a patient is suspected of having pulmonary hypertension (due to poor physical performance and impaired breathing), they will undergo a comprehensive physical examination and their medical history will be analyzed. Aside from the family medical history, it is also very important to provide details of any previous drug prescriptions and possible substance abuse.
Other possible tests:
After a patient is diagnosed with pulmonary arterial hypertension, they must learn how to adapt to the new condition.
Strenuous physical activity should be avoided since the lungs cannot provide the body with the necessary oxygen requirements any longer. Breathing difficulties are a clear sign that the strenuous activity should be stopped. However, it is very important that the patient does light exercise and walks regularly in order to maintain muscle strength and to encourage circulation.
The patient's diet should be rich in micronutrients, fiber, and vitamins. However, the intake of cooking salt should be reduced.
Alcohol should only be enjoyed in small amounts.
Bodyweight needs to be inspected at regular intervals, preferably always at the same time of the day. Sudden increases in bodyweight can be a signal of a deterioration in the heart and kidneys.
Both active and passive smoking should be avoided.
If a female patient wants to have a child it is of utmost importance for her to first consult a PAH specialist given the increased risk for expectant mothers and their unborn children caused by PAH.
A diagnosis of pulmonary hypertension causes a change in lifestyle for many people. Many patients often ask themselves what they should eat. There is no special “high-pressure lung diet”, but there are nutritional measures that can make everyday life easier, especially when coping with with diarrhea and both loss of appetite and weight.
Diarrhea is when three or more loose or watery bowel movements occur within 24 hours. The stool consistency is unshaped, which means mushy or thin. Persistent diarrhea results in significant fluid and electrolyte loss. To compensate for these losses, isotonic drinks (electrolyte drinks) are recommended because the body can absorb this liquid better than pure water or tea.
Drinking is particularly important when having diarrhea and the recommended amount is at least 1 to 1.5 liters per day!
Drinks at room temperature are optimal and carbonated drinks will cause flatulence.
Avoid drinking large amounts at once, instead drink regularly throughout the day.
Less suitable drinks:
These drinks are not suitable for low-viscosity stools because they contain too little sugar and minerals:
When digestion is intensive, easily digestible food is a much better option. In this phase, you should rather refrain from hearty home-cooked food, especially if it is greasy, fatty and stimulatesstool.
Spices such as herb salt, parsley, dill, ground nutmeg, caraway and ground vegetables (carrots, celery) and also pumpkin, courgette/ zucchini and fennel are generally well tolerated.
Pectins support intestine-function.
They help to remove harmful decomposition products from the intestine and provide food for the healthy intestinal flora. They also increase water absorption from the intestine into the blood.
Pectins are contained in apple with peel, banana, carrot, blueberries (especially dried), and jams.
Foodstuffs that slow down intestine function:
Having PAH does not increase the risk of catching the coronavirus, which is also referred to as COVID-19. Because COVID-19 is a new virus, there is no immunity in society, meaning the entire human population is prone to infection. After an infection with COVID-19 the severity of symptoms can range from very mild (or even no symptoms at all) to severe. People who are older or have existing chronic medical conditions, such as heart or lung diseases or diabetes, may be at higher risk of serious illness. Of course, PAH patients tend to be at a higher risk. We therefore urge PAH patients to please STAY at HOME. PAH patients should be cautious and try to avoid any risk of infection! COVID-19 is primarily spread via respiratory droplets when people cough or sneeze. Normally, symptoms of COVID-19 begin 2 to 14 days after exposure. These symptoms include, but are not limited to, fever, tiredness, dry cough, shortness of breath or difficulty breathing.
The following simple preventive measures can help minimize the spread of COVID-19:
Individuals with respiratory diseases, such as pulmonary hypertension, do not appear to be more at risk of contracting COVID-19 than the general public. However, if they catch COVID-19 they are more likely to suffer from severe symptoms.
Patients with respiratory diseases should, therefore, take extra precautions to minimize the risk of getting infected with COVID-19. In addition to the general preventive measures listed above, they should:
Family members and caregivers of people with chronic diseases like pulmonary hypertension should take appropriate precautions and take extra care to avoid bringing COVID-19 home. They should constantly monitor patients and stock medicines and other necessary supplies that can last for several weeks. Storing extra non-perishable food can help minimize trips to the grocery store. People who show symptoms of COVID-19 or who have been exposed to COVID-19 (e.g. having been in physical contact with COVID-19 infected people) should have to immediately stop visiting their PAH relatives/patients until the self-isolation period is complete.
It is the number of the helpline operated by the National Health Fund to provide information in case of potential coronavirus infection. If symptoms are present and a COVID-19 diagnosis is confirmed, patients should follow these steps to prevent the spread of the infection:
For information on pumps and supply of medicines used in the treatment of pulmonary hypertension please contact your local pulmonary hypertension treatment center.